Answers: 1-6 153
ANSWE RS
1. The correct answer is E. The classic signs of ir-
reversible pulpitis include pain that is intense in
nature that occurs spontaneously without a spe-
cific stimulus. Answer A is incorrect. A necrotic
pulp indicates that the affected tooth is non-
vital and would therefore have no response to
heat, cold, or sweets. Answer B is incorrect.
Acute apical periodontitis is a periapical diagno-
sis that is characterized by percussion sensitivity.
Answer C is incorrect. Reversible pulpitis is usu-
ally asymptomatic, but when there are symp-
toms, they include sharp, transient pain with hot
or cold that disappears when the stimulus is re-
moved. Answer D is incorrect. Traumatic oc-
clusion refers to tissue damage due to occlusal
forces, and symptoms include sensitivity to per-
cussion and tooth mobility.
2. The correct answer is D. At 12 years of age, the
maxillary central incisors should be fully devel-
oped with closed apices. Root canal therapy is
the treatment of choice as it is necessary to ac-
commodate the post, core, and crown needed to
restore the tooth to form and function. Answer
A is incorrect. Extraction is the last resort treat-
ment for a tooth that is nonrestorable. Answer B
is incorrect. Pulpotomy is performed on a trau-
matic exposure to preserve vital pulp tissue in
an immature tooth. Since the fractured tooth is
mature, pulpotomy is not indicated. Answer C is
incorrect. Direct pulp caps are usually reserved
for small (<0.5 mm), atraumatic mechanical ex-
posures during caries removal. Answer E is incor-
rect. Apexogenesis is a type of vital pulp therapy
in which the pulp of an immature tooth is main-
tained to allow for continued dentin formation
and root end closure. The tooth in this case is
already fully developed.
3. The correct answer is D. Root canal therapy
is considered successful in the absence of a pe-
riapical radiolucency. Rate and completion of
healing vary depending on the size of the ini-
tial lesion but should show improvement radio-
graphically in 6 months. Answers A, B, and C
are incorrect. During this time, if the bacterial
load has been decreased sufficiently, fibroblasts
and endothelial cells infiltrate, bone is replaced,
cementum and dentin are repaired by cellular
cementum, and the PDL is restored. Answer E is
incorrect. Success is defined as elimination (or
no development of) a radiolucency for at least
1 year following treatment.
4. The correct answer is B. Irreversible pulpitis is
characterized by intense, spontaneous pain that
lingers with cold stimuli. Acute apical periodon-
titis is characterized by sensitivity to percussion.
Answer A is incorrect. The pulpal diagnosis of
Endodontics
irreversible pulpitis is correct; however, a nor-
mal periapex would not respond to percussion
with pain. Answer C is incorrect. A tooth with
reversible pulpitis would not exhibit lingering
pain to cold. Answer D is incorrect. A nonvi-
tal, necrotic tooth would not respond to thermal
tests, and chronic apical periodontitis would not
respond positively to percussion tests. Answer E
is incorrect. As explained earlier, the symptoms
do not describe a necrotic tooth.
5. The correct answer is D. The number of nerves
and blood vessels in the pulp decreases with age,
and this loss of sensory innervation leads to a
decreased response to electric pulp testing with
age. Answer A is incorrect. There is a reduc-
tion in all cell types as the pulp ages, result-
ing from deposition of secondary and tertiary
dentin. Answer B is incorrect. Pulp stone for-
mation increases as the pulp ages. Answer C is
incorrect. Root canals decrease in diameter as a
result of dentin deposition and pulp stone for-
mation. Answer E is incorrect. Blood vessels de-
crease in number and undergo arteriosclerosis
changes with age.
6. The correct answer is D. Unmyelinated noci-
ceptive C fibers with a diameter less than 1 m
produce a pain with slow onset and a dull, dif-
fuse quality. They are found mainly in the core of
the pulp and are the most numerous nerve fibers.
Answer A is incorrect. When stimulated, myeli-
nated A fibers produce a fast, localized sharp
pain sensation. Answer B is incorrect. A fibers are
myelinated. Answer C is incorrect. C fibers are
 154 Chapter 6: Endodontics
unmyelinated. Answer E is incorrect. The sub-
odontoblastic plexus of Raschkow is composed
of the terminal portions of the A fibers as they
branch off, lose their myelination, and rise to the
coronal portion of the pulp around the level of
the odontoblasts.
7. The correct answer is B. This is the classic
presentation of a true endo–perio lesion. If the
periodontal prognosis of the tooth is favorable,
endodontics therapy should be initiated first.
This will prevent drainage from the periapical
lesion from interfering with the healing of the
periodontal lesion. Once definitive root canal
Endodontics
therapy has been completed, periodontal treat-
ment should be initiated. Answer A is incorrect.
If the endodontic lesion is treated without peri-
odontal therapy following, the lesion will heal
up to the base of the periodontal lesion, with-
out further resolution. Answer C is incorrect. If
the periodontal lesion is treated without the en-
dodontic therapy, the endodontic lesion will per-
sist, as will the periodontal defect, as the drainage
from the periapical area will prevent regenera-
tion from occurring. Answer D is incorrect. If the
endodontic treatment does not precede the pe-
riodontal treatment, the periodontal treatment
will not be successful. Answer E is incorrect. Ex-
traction is the last resort treatment to be used
only if the prognosis of the tooth is hopeless.
Since this condition is localized and there is no
mobility, the tooth should be treated.
8. The correct answer is C. It is helpful to attempt
to elicit the painful symptom during the diagnos-
tic process. Since cold drinks elicit pain in the
patient, a cold test should be conducted prior to
other vitality tests. Answer A is incorrect. Elec-
tric pulp testing may be an appropriate first test
in another clinical situation. Answer B is incor-
rect. Since pain is not elicited by hot drinks or
foods, the cold test is more appropriate. Answer
D is incorrect. A test cavity is never a first-line
diagnostic pulp vitality test. It is to be used only if
other tests are inconclusive and a necrotic pulp
is suspected. Answer E is incorrect. The patient
does not report sensitivity to mastication, so per-
cussion testing is not likely to elicit the symptom.
In addition, it is not a test for pulp vitality, rather
it is used to make a periapical diagnosis.
9. The correct answer is D. Tooth type should not
affect ability to achieve profound local anesthe-
sia. Answer A is incorrect. Often, patients receiv-
ing root canal therapy have been in severe pain
for a few days, preventing them from getting ad-
equate sleep. This can result in a decreased pain
threshold. Answer B is incorrect. Many patients
are fearful of root canal therapy, either as a result
of a previous bad experience or because a friend
or family member had a bad experience. As a re-
sult, their pain threshold is decreased. Answer C
is incorrect. If the periodontium is inflamed, pa-
tients may experience hyperalgesia or a painful
reaction to a normal stimulus. In addition, it has
been hypothesized that because the inflamed tis-
sue is more acidic than normal, there is less local
anesthetic available in its basic form to penetrate
the nerve. Answer E is incorrect. Patients who
have had previous difficulty achieving anesthe-
sia are more likely to have anxiety and, as a result,
are more likely to have problems in the future
with anesthesia.
10. The correct answer is D. We are able to de-
termine that the mesially shifted canal is posi-
tioned lingually by using the SLOB rule. As the
x-ray cone moves in the horizontal direction,
the object that moves in the same direction is
positioned lingually (Same, Lingual), and the
object that moves in the opposite direction is
positioned buccally (Opposite, Buccal). Answer
A is incorrect. The two canals in the distal root
of a mandibular molar are positioned buccally
and lingually. Answer B is incorrect. The two
canals in the distal root of a mandibular molar
are positioned buccally and lingually. Answer C
is incorrect. If the canal was positioned buccally,
it would have moved distally, in the opposite di-
rection of the cone. Answer E is incorrect. As
was stated earlier, the SLOB rule can be used
to determine the orientation of the files in the
distal canal.
11. The correct answer is B. The first number is
a measure of the diameter of the tip of the
k-file (30 = 0.30 mm). The second number is
a measure of the length of the k-file (25 mm).
The file diameter (taper) increases at a regular
rate of 0.02 mm up the shaft of the instrument
in k-files. Answer A is incorrect. The value 30 is

the measure of the diameter of the tip of the file,
not the length, and 25 mm is the measure of the
length of the file, not the diameter of the tip. An-
swer C is incorrect. The taper of k-files is 0.02,
not 30, although the measure of the length is
25 mm. Answer D is incorrect. While 30 is the
measure of the diameter of the tip of the file,
the taper of k-files is 0.02. Answer E is incorrect.
The value 30 is a measure of the diameter of the
tip of the file, and 0.02 would represent the taper
of the file, not 25 mm.
12. The correct answer is C. Dens evaginatus usu-
ally presents as a tubercle, most commonly in
the mandibular premolars of Asian individuals.
They often contain pulp tissue, as when they
fracture off or wear down as a result of attrition,
the pulp may become exposed. Answer A is in-
correct. This correct pulpal diagnosis for this pa-
tient is necrotic pulp, as there is no response to
pulp vitality tests, and there is destruction of the
periodontium. Answer B is incorrect. Dens in-
vaginatus most commonly occurs in the lingual
of maxillary lateral incisors and is an infolding
rather than an outgrowth of the enamel organ. It
can also result in communication between the
oral cavity and the pulp and would be treated
with root canal therapy as would dens evagi-
natus. Answer D is incorrect. Pulp stones form
within the pulp, possibly as a result of irritation
and are often seen as radiopaque on radiographs.
Answer E is incorrect. Internal resorption occurs
as a response to irritation, and it may be small
and almost undetectable or so destructive that it
causes root perforation.
13. The correct answer is C. The apical constric-
tion, assumed to be at the junction of the ce-
mentum and the dentin, is reliably measured by
apex locators and is usually 0.5 mm from the api-
cal foramen. It is the accepted determinant for
working length determination. Answer A is in-
correct. The anatomic apex, which may also be
called the radiographic apex, is the most apical
portion of the root. We do not work to this length,
as the apical foramen rarely coincides with the
anatomic apex. Answer B is incorrect. The api-
cal foramen is usually 0.5 mm from the radio-
graphic/anatomic apex. Usual working length is
Answers: 7-16 155
0.5 mm short of the apical foramen at the apical
constriction.
14. The correct answer is E. The access form is
triangular for the maxillary central incisor, the
maxillary first molar, and the maxillary second
molar. Answer A is incorrect. The access form
for the maxillary central incisor is triangular and
the access forms for both mandibular central in-
cisor and maxillary lateral incisor are ovoid. An-
swer B is incorrect. The access forms for both
mandibular central incisor and the maxillary first
premolar are ovoid, and the access form for the
maxillary first molar is triangular. Answer C is
Endodontics
incorrect. The access forms for the maxillary ca-
nine, the maxillary first premolar, and the max-
illary lateral incisor are all ovoid. Answer D is
incorrect. The access form for the maxillary sec-
ond molar is triangle, the access form for the
mandibular first molar is trapezoidal, and the
access form for the maxillary lateral incisor is
ovoid.
15. The correct answer is B. A restoration that has a
proper seal will prevent recurrent caries and bac-
terial recontamination of the root canal system,
ensuring success of the root canal therapy. An-
swer A is incorrect. The type of final restoration
placed after endodontic therapy is unimportant
as long as the marginal integrity is maintained
and proper cuspal coverage is achieved where
needed. Answer C is incorrect. The type of tem-
porary sealing material is not important, as long
as the seal is tight and it is not left in for more
than approximately 3 months. Answer D is in-
correct. Placement of a post is used strictly as a
means for retaining core material in a tooth that
has lost significant coronal structure. It does not
provide a coronal seal until a final restoration is
placed. Answer E is incorrect. The type of sealer
used during obturation does not affect the suc-
cess of the procedure, the fit of the gutta percha
is a more important factor in sealing the apex.
16. The correct answer is D. The first step in all pa-
tients’ visits should be a complete review of their
medical and dental history, whether it is their
first visit or not. Following this, it is important
to ascertain the details of their chief complaint
including information about the duration and
 156 Chapter 6: Endodontics
the quality of pain and what, if any, stimuli exac-
erbate it. Next, an extraoral examination should
be completed, noting any areas of swelling, ten-
derness, or lymphadenopathy. After the extrao-
ral examination, a complete intraoral examina-
tion should be completed, including appropriate
pulp vitality tests and percussion and palpation
tests. Finally, a determination should be made
as to what radiographs are needed, followed by
interpretation. Answer A is incorrect, answer B
is incorrect, answer C is incorrect, answer E is
incorrect; see the earlier reasons.
17. The correct answer is D. Failure to direct the
Endodontics
bur parallel to the long axis of the tooth dur-
ing access preparation can result in crown or
root perforation. Perforation into the PDL usu-
ally results in hemorrhage that is difficult to con-
trol. Pain may occur as the operator attempts
to place an instrument through the perforation
and enters the PDL. A burning sensation or a
bad taste can be detected during irrigation with
sodium hypochlorite as the solution exits the root
canal system. Answer A is incorrect. Inadequate
straight line access may be a cause of root per-
foration and many other procedural errors that
may occur during root canal therapy, but it is
not the direct cause of the listed symptoms. An-
swer B is incorrect. Root canal contamination
would not result in the immediate symptoms but
would cause more long-term problems such as
intervisit emergencies or, ultimately, root canal
failure. Answer D is incorrect. Incomplete root
canal debridement would result in problems
similar to root canal contamination. Answer E
is incorrect. Ledging can result in incomplete
root canal debridement and inadequate obtu-
ration, none of which would cause the listed
symptoms.
18. The correct answer is A. To maintain the pa-
tency of the canal and to maintain the working
length, it is necessary to recapitulate frequently
and use irrigation and lubrication. Other causes
of ledging include inadequate straight line ac-
cess, retention of debris in the apical end of
the canal, and excessive enlargement of curved
canals. Answer B is incorrect. An instrument sep-
aration is possible but is not the best answer.
An instrument that has been broken will show a
blunted tip, signaling that an error has occurred.
Answer C is incorrect. A vertical root fracture
most often occurs during postcementation or
condensation during obturation. It would not
present with a sudden inability to reach work-
ing length and usually would not occur during
routine instrumentation. Answer D is incorrect.
Inadequate straight line access may be one of the
causes of ledging but would not directly cause a
sudden loss of working length. Answer E is in-
correct. A furcation perforation might prevent
an operator from accurately measuring working
length if a file were inserted through the perfora-
tion, but it would not result in a sudden inability
to reach working length.
19. The correct answer is D. The initial strategy for
a separated instrument is to try and bypass the
instrument in the same way you would bypass
a ledge. If this is successful, broaches or Hed-
strom files can be used in attempt to remove
the separated segment. If this is possible, the
canal is cleaned, shaped, and obturated to work-
ing length. If it is not possible to remove the
segment, the canal is cleaned, shaped, and ob-
turated to the new working length at the most
coronal portion of the separated instrument. An-
swer A is incorrect. Extraction is the last resort of
treatment, usually reserved for failed root canal
therapy or nonrestorable teeth. The prognosis of
a tooth with a separated instrument left in the
canal depends on how much debridement had
been finished prior to the separation, and the
procedure should be deemed a failure before
extraction. Answer B is incorrect. Similar to ex-
traction, root amputation is usually reserved for
cases in which root canal therapy has failed or a
portion of a tooth is periodontally involved. An-
swer C is incorrect. Bicuspidization of a tooth,
similar to root amputation, is usually not a first-
line treatment for instrument separation. Answer
E is incorrect. It is not acceptable to leave any
canals in a root canal treated to unobturated.
The treatment would be incomplete and would
result in definite failure.
20. The correct answer is A. Aspiration of instru-
ments can be avoided by judicious use of rubber
dam isolation, which is the standard of care dur-
ing root canal therapy. Answer B is incorrect.

If a tooth is properly isolated, there is no risk
of instrument aspiration. Answer C is incorrect.
Using proper lubrication may help to avoid in-
strument separation, but it will not prevent as-
piration. Answer D is incorrect. Recapitulation
is important in maintaining working length, not
in preventing instrument aspiration. Answer E
is incorrect. Frequent irrigation is necessary for
complete debridement of the canals, not for the
prevention of aspiration.
21. The correct answer is E. Narrow pockets to the
level of the fracture and J-shaped or teardrop-
shaped radiolucencies are indicative of vertical
root fractures. The only way to definitively diag-
nose a vertical root fracture is to see it during
an exploratory surgical procedure. The progno-
sis of a root with a vertical fracture is hopeless,
and it should be amputated or the tooth must be
extracted. Answer A is incorrect. Incomplete de-
bridement of canals can lead to root canal failure
but will not present with the narrow pocketing
or J-shaped lesions of a fractured root. Answer B
is incorrect. Ledging can also lead to failure if
the canal has not been fully debrided or filled
to original working length. Answer C is incor-
rect. Underobturation can result in failure if de-
bris remains in the apical portion of the canal
or the apical seal is compromised. Answer D is
incorrect. A periodontal abscess does not usu-
ally present as a narrow defect to the apex of a
tooth.
22. The correct answer is B. The persistence of
swelling, sinus tracts, spontaneous or dull pain,
or pain of biting, in addition to lack of resolution
of periapical lesions, all indicate root canal fail-
ure. Answer A is incorrect. The more likely rea-
son for these symptoms to remain is a failed root
canal procedure. Answer C is incorrect. Trigemi-
nal neuralgia typically presents with intense pain
that is more intense than applied stimuli, re-
ferred pain, and trigger points. These are not
typical presentations for failed root canal ther-
apy. Answer D is incorrect. This is possible if the
treated tooth was restored to high occlusion and
the PDL was irritated; however, the more likely
answer, considering the radiographic evidence,
is root canal failure. Answer E is incorrect.
Myofacial pain is usually not as localized as the
Answers: 17-24 157
presenting symptoms and will typically present
as worse during particular times of the day, upon
waking in the morning, for example.
23. The correct answer is D. A root canal is con-
sidered successful if there is an absence of signs
and symptoms including all of those mentioned.
Answer A is incorrect. If a patient is experienc-
ing swelling or periodontal pocketing, the root
canal procedure is deemed a failure. Answer B
is incorrect. If a sinus tract fails to heal, the root
canal therapy was not successful. Answer C is in-
correct. Pain and periapical lesions that do not
decrease in size are signs of root canal failure.
Endodontics
Answer E is incorrect. In order for a root canal
to be deemed a success, periapical lesions must
decrease in size and/or resolve.
24. The correct answer is A. The decision to per-
form retrograde or orthograde retreatment is
highly dependent on the circumstances of each
individual patient. In certain circumstances, if it
would be more costly and time consuming to fab-
ricate a new restoration following conventional
retreatment, it is acceptable to consider apicoec-
tomy procedures as initial retreatment modali-
ties. Answer B is incorrect. It is necessary to help
patients deal with their anxiety, and avoidance
of a procedure due to patient anxiety is not an
acceptable treatment option. It is quite common
for patients to have higher anxiety surrounding a
retreatment procedure than an initial treatment,
but it is not a reason to choose one treatment
over another. Answer C is incorrect. Retrograde
treatment does not function to remove microor-
ganisms from the root canal system, orthograde
treatment accomplishes this. Rather, the goal of
retrograde treatment is to prevent microorgan-
isms from leaving the root canal system. Answer
D is incorrect. When root canal filling mate-
rials are easy to remove, it makes orthograde
retreatment a better option than retrograde re-
treatment. Answer E is incorrect. Treatment is
not decided on the bass of the preference of the
dentist, it should be based on the best progno-
sis for the patient. In addition, if practitioners
feel they are unable to properly perform the best
procedure for the patient, the case should be re-
ferred to another practitioner who can.
 158 Chapter 6: Endodontics
25. The correct answer is C. An 8-year-old child will
have maxillary central incisors with immature
apices. Because this is a vital exposure, vital pulp
therapy including a shallow pulpotomy should
be the treatment of choice. This will result in
the remaining vital pulp to continue to allow
the apex to develop normally. Once the apex has
formed, traditional root canal therapy should be
completed. Answer A is incorrect. Root-end clo-
sure should be used only to treat nonvital teeth
with immature apices because there is no possi-
bility of further growth of the tooth structure.
Answer B is incorrect. Traditional root canal
therapy is not possible on a tooth with an open
Endodontics
apex as it is hard to form an acceptable apical
seal. Answer D is incorrect. A partial pulpec-
tomy would remove vital pulp tissue from the
root canal system, making continued root for-
mation less likely. Answer E is incorrect. Tem-
porization without a shallow pulpotomy would
potentially allow for bacterial contamination of
the pulp and root canal system.
26. The correct answer is D. Intrapulpal hemor-
rhage occurs as the result of injury to coronal
blood vessels, usually suffered during impact
to a tooth. The hemorrhaged red blood cells
and their disintegration products stain the sur-
rounding dentin, and it tends to increase over
time. Answer A is incorrect. Endemic fluorosis is
caused by ingestion of too much fluoride during
tooth formation. Teeth may erupt with a chalky
appearance, getting discolored only after they
absorb stains from the oral cavity. Answer B is in-
correct. Discoloration from systemic drugs, most
often tetracycline, is usually bilateral and can
range from yellow to dark gray depending on
the exposure. Answer C is incorrect. Enamel
hypocalcification usually appears as a distinct
brown or white area on the crown of a tooth.
Answer E is incorrect. Amelogenesis imperfecta
may result in yellow or brown discolorations,
usually affecting more than one tooth.
27. The correct answer is B. Incompletely remov-
ing the sealer or gutta percha after obturation is a
common cause of tooth discoloration following
root canal therapy. This dark discoloration can
be prevented by maintaining pulp chamber with
clean walls prior to final restorative treatment.
Answer A is incorrect. As long as the coronal seal
was adequate, sealer remnants in the pulp cham-
ber would not lead to root canal failure. Answer
C is incorrect. Vertical root fracture is most often
caused during the placement of a post. Leaving
the sealer in the chamber would not increase
the chance of vertical root fracture. Answer D
is incorrect. The sealer remaining in the cham-
ber should not prevent an adequate coronal seal.
Answer E is incorrect. Because it is possible to
obtain a coronal seal even if the sealer is left in
the chamber, it would not be the direct cause of
bacterial leakage.
28. The correct answer is C. Sodium perborate is
a powder that decomposes into hydrogen perox-
ide and oxygen in the presence of acid or water.
It is safer and less damaging to tissues than hy-
drogen peroxide and is therefore the material of
choice for internal bleaching. Answer A is incor-
rect. Hydrogen peroxide is an oxidizer that is un-
stable in high concentrations and tends to burn
tissue. Therefore, sodium perborate is a better
choice for the bleaching procedure. Answer B
is incorrect. Carbamide peroxide is used for ex-
ternal bleaching and not for internal bleaching
procedures.
29. The correct answer is C. When a fluctuant
swelling is incised, the purulence is released im-
mediately and a relief is felt right away. Answer
A is incorrect. A tooth with reversible pulpitis
and pain on mastication does not need incision
for drainage or root canal therapy. Rather, the
offending stimulus must be removed to relieve
the symptoms. Answer B is incorrect. A necrotic
tooth with an indurated swelling may be incised
for drainage; however, the outcome is less pre-
dictable. Relief of pressure will most likely be
felt; however, it is possible that only blood or
serous fluid will be released. Answer D is incor-
rect. A tooth without a swelling is a contraindi-
cated for incision for drainage. Answer E is in-
correct. A tooth without swelling is a contraindi-
cated for drainage.
30. The correct answer is B. All vitality testing and
the lack of symptoms should lead you to deter-
mine that the tooth is vital; therefore, a peri-
radicular lesion should not be attributed to an

infection originating in the root canal system.
In addition, the patient’s history of malignancy
makes a biopsy the correct treatment for the un-
defined lesion. Answer A is incorrect. Because
the tooth is vital, with no symptoms and an intact
restoration, a pulpotomy should not be per-
formed. Answer C is incorrect. Root canal ther-
apy should not be the treatment of choice for this
tooth for the same reasons as pulpotomy is not
the treatment of choice. Answer D is incorrect.
The tooth should not be extracted except as the
last resort if the biopsy is positive for malignancy
and it was determined that all of the malignant
could not be removed without extraction.
31. The correct answer is B. The percussion test
determines whether or not there is inflamma-
tion in the periodontal ligament. Answer A is
incorrect. The percussion test cannot be used
to determine whether a tooth is vital or not and
should not be used as a test to determine whether
root canal therapy is indicated as a treatment op-
tion. Answer C is incorrect. The palpation test
would be used to determine whether inflamma-
tion has spread from the PDL to the surrounding
periodontium. Answer D is incorrect. Although
percussion sensitivity is common in the presence
of a root fracture, it is not diagnostic. Answer E
is incorrect. To determine the vitality of a tooth,
other tests would be employed, including elec-
tric pulp testing and cold testing.
32. The correct answer is B. Electric pulp testing
produces a high incidence of both false-positives
and false-negatives. As a result, it is not a defini-
tive test, and additional diagnostic aids should
be used. Answer A is incorrect. Because elec-
tric pulp testing is not definitive, a diagnosis of
necrotic at this point would be premature. An-
swer C is incorrect. A definitive treatment plan
cannot be made until a definitive diagnosis is
made. Answer D is incorrect. Electric pulp test-
ing measures the level of stimulation for sensory
nerves within the pulp, giving no information
about inflammation. The proper test to diag-
nose inflammation in the PDL would be per-
cussion. Answer E is incorrect. Calcified canals
may lead to an electric pulp test reading that
suggests necrosis but can be diagnosed only by
radiographic or clinical examination.
Answers: 25-35 159
33. The correct answer is D. A tooth with irre-
versible pulpitis will react with severe pain, re-
producing the chief complaint of the patient that
lingers after the stimulus is removed. Answer A
is incorrect. No response to Endo Ice would in-
dicate a necrotic pulp. Answer B is incorrect.
Severe pain that does not linger after removal of
the stimulus is indicative of reversible pulpitis.
Answer C is incorrect. Mild to moderate pain
that does not linger after removal of the stimulus
is indicative of a normal pulp.
34. The correct answer is D. Indications for direct
pulp cap therapy include permanent teeth in
Endodontics
which there has been a pinpoint mechanical ex-
posure of a vital, asymptomatic tooth. Bleeding
must be controlled, and the pulp cap material
must make direct contact with the exposure. An-
swer A is incorrect. A pulpotomy is indicated
in primary teeth with exposed vital pulps or ir-
reversible pulpitis. It is indicated in permanent
teeth as a temporary emergency procedure to
alleviate symptoms prior to conventional root
canal therapy or in permanent teeth with im-
mature apices to encourage further root devel-
opment and closure. Answer B is incorrect. An
indirect pulp cap is indicated on permanent
teeth with immature apices if there is a cari-
ous lesion, which, if removed, will result in a
pulpal exposure as long as the tooth is asymp-
tomatic with no periapical pathology. Answer C
is incorrect. Root canal therapy would be indi-
cated in this case if the direct pulp capping pro-
cedure failed, resulting in symptoms. Answer E
is incorrect. A conventional amalgam restora-
tion may be placed only if there is no pulpal
exposure.
35. The correct answer is E. The outline of the
access cavities for both the first and second
mandibular molars is trapezoid. Answer A is in-
correct. The outline of the access cavity for the
maxillary first molar is triangular, and the out-
line of the access cavity for the mandibular first
molar is trapezoid. Answer B is incorrect. The
outline of the access cavity for the mandibular
first molar is trapezoid, and the outline of the
access cavity for the maxillary second molar is
triangular. Answer C is incorrect. The outline of
the access cavity for the maxillary first molar is
 160 Chapter 6: Endodontics
triangular, and the outline of access cavity for the
maxillary second premolar is ovoid. Answer D is
incorrect. The outline of the access cavity for
the mandibular second premolar is ovoid, and
the outline of the access cavity for the maxillary
second molar is triangular.
36. The correct answer is C. A complicated crown
fracture involves the enamel, dentin, and pulp.
Answer A is incorrect. A root fracture involves
cementum, dentin, and pulp. Answer B is in-
correct. A crown–root fracture involves enamel,
dentin, and cementum and may or may not in-
volve the pulp. Answer D is incorrect. An un-
Endodontics
complicated crown fracture involves the enamel
and dentin but not the pulp.
37. The correct answer is D. Calcium is a white
powder with a high pH and is applied to
the canals between appointments as a cream
mixed with sterile water. It is antibacterial and
prevents bacterial growth between treatments.
Calcium hydroxide is also used to encourage
calcification in pulp capping, apexogenesis, and
apexification procedures. Answer A is incorrect.
Sodium hypochlorite is an acidic liquid that acts
as a solvent on organic debris and also as an an-
tibacterial agent. It is the irrigation solution of
choice but is very caustic and can cause severe
reactions if extruded past the apex. Answer B
is incorrect. Ethylenediaminetetraacetate dem-
ineralizes dentin and removes inorganic mate-
rial. It is used to remove the dentin smear layer
and is the main ingredient in many canal lu-
bricants. Answer C is incorrect. Chlorhexidine
is an antiseptic used to inhibit bacteria but is
not used as an interappointment canal medica-
tion. Answer E is incorrect. Gutta percha is an
obturating material that would be used only to
definitively seal a clean root canal.
38. The correct answer is E. Milk and Hank bal-
anced salt solution provide the best conditions
in which to store an avulsed tooth due to their
osmolality. Answer A is incorrect. Storing an
avulsed tooth dry would give it the worst progno-
sis. Answer B is incorrect. Along with dry storage,
storage in tap water provides the worst progno-
sis for an avulsed tooth. Answer C is incorrect.
If neither milk nor Hank solution were avail-
able, saline would be a good storage option.
Answer D is incorrect. Saliva could be used in
place of saline if milk or Hank solution were not
available.
39. The correct answer is B. A tooth that had been
avulsed more than an hour earlier and not stored
in an appropriate liquid medium is generally not
replanted as the prognosis is very poor. Answer
A is incorrect. If the tooth had been avulsed less
than an hour prior and had been stored properly,
root canal therapy would have been completed
only after a week of splinting to reduce mobil-
ity. Answer C is incorrect. If the tooth had been
avulsed less than an hour prior and had been
stored properly, this would be a correct proce-
dure, followed by flexible splinting for a week
and definitive root canal therapy. Answer D is
incorrect. This would have been the proper treat-
ment plan for a tooth avulsed less than an hour
prior that had been stored in the proper liquid
medium.
40. The correct answer is D. Pulpal therapy is not
indicated for this tooth, so extraction is the only
viable treatment option. Answer A is incorrect.
The pulp is already exposed in this case, so indi-
rect pulp capping in no longer an option. Answer
B is incorrect. Direct pulp caps are not indicated
for primary teeth as the low pH of calcium hy-
droxide will irritate the pulp and cause internal
resorption. Answer C is incorrect. Pulpotomy is
contraindicated on primary teeth if more than
one-third of the root has already resorbed, if there
is internal resorption, if the furcation is perfo-
rated, or if there is a periradicular lesion that
may damage the succedaneous tooth. Answer E
is incorrect. Root canal therapy is indicated only
for primary teeth when there is no evidence of a
succedaneous tooth, when there is no evidence
of periradicular lesions, and when treatment will
not damage the succedaneous tooth.
41. The correct answer is C.
A. This would be inaccurate because the fistula
may be located between the teeth.
B. This is wrong because the patient may have
referred pain on adjacent teeth.

C. Although this is a good diagnostic tool to
identify vertical fracture, it is not sufficient
to identify the source of the fistula.
D. A fistulous tract cannot be seen on a radio-
graph.
42. The correct answer is E. The fact that the patient
sustained trauma to her tooth is not an indication
to initiate root canal treatment. Clinically, the
tooth is not exposed. The accident happened
only 1 hour ago, which is not a sufficient time for
radiographic changes. Splinting is optional but
not necessary since there is only slight mobility.
The luxation caused inflammation around the
periodontal ligament, but there is a good chance
that it will resolve on its own. Observation and
radiographic monitoring is the right treatment at
this time.
A. Tooth is not exposed; therefore, no root canal
treatment is indicated.
B. Treatment for luxated teeth is initiated with
2 weeks of passive splinting to allow for
reattachment of periodontal ligament and/or
ankylosis of the tooth. RCT is initiated after
confirming unsuccessful reattachment and
pulpal necrosis.
C. See reasons presented earlier.
D. Surgical removal of the apical segment is
usually the treatment of choice in cases when
infection develops or persists AFTER root
canal therapy.
43. The correct answer is B. All the other answers
call for removal of periodontal ligament, which
is wrong, since it contains viable cells neces-
sary for successful implantation. It is necessary
to only gently remove gross debris.
44. The correct answer is D. There may be extensive
bone destruction in the vicinity of the infected
tooth, such as perforation of both labial and lin-
gual cortical plates; sometimes, it takes years
for the bone to fill the defect, and sometimes
this does not happen at all. Instead, the area
fills with scar tissue. Answer A is wrong because
chronic apical periodontitis is generally a condi-
tion in which the apical portion of a tooth’s root
is chronically inflamed. There may be drainage
through the gums from around the tooth’s root.
Answers: 36-49 161
This resolves following successful treatment of
the condition with RCT. Answer B is wrong be-
cause foreign-body reaction would present with
swelling, irritation, and redness in the area. An-
swer C is wrong because apical radicular cyst is a
fluid-filled sac at the apex of the tooth following
necrosis of the pulp, which usually resolves with
RCT. Answer E is wrong because patient cannot
have irreversible pulpitis AFTER the root canal
therapy.
45. The correct answer is D. A complete resolu-
tion of the infection does not necessarily coin-
cide with completion of root canal therapy. This
Endodontics
condition will probably resolve on its own once
the host immune system completely eliminates
the infection. No treatment is indicated for this
asymptomatic presentation. All other choices
recommend a treatment much too aggressive for
an asymptomatic tooth.
46. The correct answer is B. NaOCl is an irrigating
solution. Answer A is incorrect because xylol is
an aromatic isomer used as a solvent. Answers
C and D are incorrect because they are organic
solvents used in gutta percha removal.
47. The correct answer is D. Transportation will
occur on the OUTER curve of canal walls, not
the inner due to files returning to their linear
form throughout treatment. Answers A, B, and
C are incorrect because transportation occurs is
the outer curve of the canal wall. Answer E is
incorrect because files due have the tendency to
return to their linear form.
48. The correct answer is C. Bleaching material is
acting up facial/esthetic portion of the tooth. A,
B, and D are incorrect.
49. The correct answer is D. Hedstrom files are
made from a tapered wire only, K-files and
Reamers are made from various shaped wires
and use a twist-and-pull method. Answer A is in-
correct because Hedstrom wires are made from
a tapered wire only. Answer B is incorrect be-
cause Hedstrom wires are made from tapered
wire only; second part is correct. Answer C is in-
correct because Hedstrom wires are made from
 162 Chapter 6: Endodontics
tapered wire only and DO produces cutting
effect only with pulling strokes.
50. The correct answer is C. Alkaline pH causes in-
ternal resorption in primary dentition. Answers
Endodontics
A, B, and D are incorrect because calcium hy-
droxide causes internal resorption in primary
dentition, reparative dentition formation in per-
manent dentition, and produces an antimicro-
bial effect, respectively.